Provider Demographics
NPI:1891922753
Name:FOUNTAINE, STACI GENEE (PPS, MA)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:GENEE
Last Name:FOUNTAINE
Suffix:
Gender:F
Credentials:PPS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3289
Mailing Address - Country:US
Mailing Address - Phone:925-682-8000
Mailing Address - Fax:
Practice Address - Street 1:1026 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3289
Practice Address - Country:US
Practice Address - Phone:925-682-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor